Management Of Acute Mastoiditis Research Articles

Acute Mastoiditis in a Young Child

Acute mastoiditis is a serious complication of acute otitis media. It is a destructive inflammatory disease of the mastoid bone. There is no consensus on the management of acute mastoiditis in children. Proper choice of the treatment regimen according to the presentation of the patient and the patient's response to therapy is critical to prevent further complications. We report the case of a 3-month-old child with acute otomastoiditis complicated by subperiosteal and subcutaneous abscesses. He was successfully managed with intravenous antibiotics, incision and drainage of the abscesses, and myringotomy tube insertion without the need for mastoidectomy.

Epidemiology and variability in management of acute mastoiditis in children

BackgroundTo evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship. MethodsWe conducted a retrospective observational study of children aged >6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011—2019). Electronic medical records were reviewed to collect data. ResultsA total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3–10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107–0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29–12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (>10 and >14 days) did not affect readmission rates for AM without ICE. ConclusionThere is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.

Management of Acute Mastoiditis and Accompanying Complications in Pediatric Patients: Single Center Experience

Management of Acute Mastoiditis and Accompanying Complications in Pediatric Patients: Single Center Experience

Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine.

ObjectiveTemporal bone computed tomography (CT) requires a relatively high radiation dose to produce high-resolution images required to define surgical anatomy. In the acute setting, the need for this detailed evaluation of temporal bone pathology may not be required for nonsurgical management and clinical decision-making. We performed a retrospective review of the clinical characteristics and subsequent management of children who underwent CT of the temporal bone with the goal of optimizing clinical decision-making and mitigating the risks of radiation exposure in children.MethodsWe included pediatric patients (<18 years of age) with International Classification of Diseases (9th or 10th revision) diagnoses consistent with otitis externa, otitis media, mastoiditis, head trauma, temporal bone fracture, and otalgia who were treated in the emergency department and underwent temporal bone CT from January 1, 2012–December 31, 2016. We collected data regarding the patients’ presenting symptoms, physical exam findings, indications for imaging, radiographic findings, disposition, and operative intervention within 30 days of imaging. Features of the suspected mastoiditis group were compared between operative and non-operative patients.ResultsOver the four-year study period there were 96 temporal bone CTs. Most studies (70%) were associated with a subsequent inpatient admission. Common indications for imaging included evaluation of acute mastoiditis (55%) or trauma (41%). Of the 53 patients with concern for mastoiditis, 27 (51%) required otologic surgery. Two patients in the trauma group required surgical intervention, both for facial nerve decompression. In patients with suspected mastoiditis, mental status changes (P = 0.02), auricular proptosis (P = 0.05), and fluctuance (P = 0.02) were significantly more prevalent in the operative group; however, no other findings were significantly associated with operative intervention.ConclusionTemporal bone CT is beneficial in guiding diagnosis and management of acute mastoiditis. We found that a majority of patients with suspected mastoiditis who underwent temporal bone CT ultimately required surgery or hospital admission. However, the potential for reduction in the use of CT still exists in this population. Fractures of the temporal bone typically do not require urgent operative intervention in the absence of complete facial nerve paralysis; thus, the utility of temporal bone CT in trauma evaluation may be limited.

Our experience on the management of acute mastoiditis in pediatric acute otitis media patients

ObjectiveThe incidence of complications due to acute otitis media (AOM) in childhood has decreased significantly with the use of new antibiotics in recent years. However, acute mastoiditis (AM) is still the most common complication that can lead to further intracranial conditions with high morbidity. Our study aimed to evaluate the clinical characteristics of children with AM and identify possible indicators for further intracranial complications associated with this condition. MethodsChildren hospitalized in our clinic with a diagnosis of AM were reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatments modalities, and culture results were screened. The patients were divided into two groups as those with and without intracranial complications (ICCs). Routine complete blood count tests, biochemical analysis, and C-reactive protein (CRP) level measurement were evaluated and compared between the groups. ResultsOf the 28 AM patients, five (17.9%) had isolated AM. Complications associated with AM included sub-periosteal abscess (28.6%), facial paralysis (25%), meningitis (17.9%), meningitis with sigmoid sinus thrombosis (7.1%), and meningitis with cerebellar abscess (3.6%). Eight patients developed ICCs (28.6%), of whom three had more than one complication. Ceftriaxone was found to be the first-line medical treatment (57.1%). Streptococcus pneumoniae was the most common pathogen isolated from the cultures (42.9%). Three patients (10.7%) were treated non-surgically, eight (28.6%) with myringotomy and ventilation tube (VT) insertion, eight patients (28.6%) with abscess drainage and VT insertion, and nine (32.1%) with cortical mastoidectomy and VT insertion. There was no significant difference between the patients with and without ICCs in terms of complete blood count parameters. The CRP level and the CRP-albumin ratio were significantly higher in patients with ICCs than those without these complications (p < 0.001). ConclusionAM remains to be the most common complication of AOM in childhood and can lead to further life-threatening conditions. Additional interventions according to the type of the complication with VT insertion is safe and effective in the management of AM. In patients with AM, it is of great importance to determine whether there is an accompanying ICC. The CRP-albumin ratio is a simple and reliable calculation to detect ICCs in patients with AM.

Management of Acute Mastoiditis With Immediate Needle Aspiration for Subperiosteal Abscess.

The management of children with acute mastoiditis (AM) is still debated. Some advocate computed tomography (CT) and cortical mastoidectomy (CM) for all cases while others favor a more conservative management. This study assesses the safety and outcome of a conservative management scheme, with immediate myringotomy and postauricular needle aspiration (PANA) of a subperiosteal abscess (SPA). A retrospective cohort of children with AM younger than 12 years admitted to our institute between 1999 and 2017. Data collection includes patient characteristics, signs and symptoms, physical examination, laboratory tests, treatment regime, imaging findings, and long-term outcomes. The study included 283 children. Ninety-eight children (34.6%) had a suspected SPA on admission and underwent a trial of immediate PANA, and 56.1% (55 cases) were positive. Of these 55, 83.6% (46) did not require CM. Twenty-four additional children had an SPA, proven by CT or during surgery, bringing the total SPA cases to 79 (27.9%). Of all children with proven SPA, 70.9% (56) did not require CM, with the practiced conservative management sufficing. Intracranial complication rates were 4.9% (14) and 8.8% (25) underwent CM. Long-term follow-up was available for 250 children. One child had hearing loss with a bilateral mixed hearing loss (50 decibels). There were no cases of neurological sequela. Conservative management of AM, involving prompt myringotomy for all patients and PANA for SPA, is safe and effective, and reduces the need for CT and CM. Conservative management obviates unnecessary radiation, general anesthesia, and surgery, without increasing the risk of immediate or long-term complications.

Acute Otologic Infections in Pediatric Patients

AbstractThis article summarizes significant acute infections involving the pediatric temporal bone. First, the management of acute otitis media (AOM) is discussed, including the medical and surgical management of invasive intracranial and extracranial complications associated with advanced disease. The clinical and radiographic findings, microbiology, and management of acute mastoiditis are discussed in greater detail, followed by the presentation and treatment of acute otitis externa (AOE). Finally, we discuss infectious considerations in auditory implants. The indications and use of both cochlear implants (CI) and bone conduction hearing implants have rapidly expanded in children, requiring greater understanding of managing infections in the context of these devices.

Management of paediatric acute mastoiditis: systematic review.

Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management. To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes. A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases. Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively. Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.

Challenges in the management of acute mastoiditis in children.

Acute mastoiditis (AM) is a rare but serious complication of otitis media. Recent studies consolidated the role of Streptococcus pyogenes as the second most important etiologic agent of AM and suggested an increased involvement of a relatively new pathogen (Fusobacterium necrophorum). The recently accumulated evidence on AM epidemiology in children is conflicting and not convincing in demonstrating clear trends during the last years. While a significant decrease was recorded in the incidence of pneumococcal invasive disease and complicated AOM following the introduction of the pneumococcal conjugate vaccines, data on the efficacy of these vaccines in the prevention of AM are limited and did not show any remarkable changes in the dynamics of disease caused by Streptococcus pneumoniae. The clinical findings in AM may differ according to the causative pathogen and different patient age subgroups. Together with computerized tomography, magnetic resonance imaging became frequently used, particularly in the diagnosis of AM complications. Simple mastoidectomy remains the most reliable and effective surgical intervention for the treatment of subperiosteal abscesses.

Diagnosis and management of acute mastoiditis in a cohort of Italian children

Objective: The Italian Society for Pediatric Infectious Diseases created a registry to determine the management of pediatric acute mastoiditis (AM) in Italy. Methods: A cross-sectional survey of paediatricians was conducted to evaluate hospitalization due to AM in Italian pediatric wards between 1 January 2002, and 31 December 2013. Results: A total of 913 children (561 males, 61.4%) were included in this study. The annual number of AM cases significantly increased during the study period (30 in 2002 and 98 in 2013) but only among older children (≥4 years old; p = 0.02). AM complications occurred in 69 (7.6%) of the children and sequelae were observed in 13 (1.4%) patients. Conclusion: The annual number of pediatric AM cases admitted to Italian pediatric wards increased in the past few years; this increase was strictly age-related. The risk of severe AM complications appeared relatively low, and most AM cases could be treated conservatively.

The management of acute mastoiditis in children with cochlear implants: Saving the device

ObjectiveEarly treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention.MethodsA retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed.ResultsThe median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage.DiscussionRecent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy.ConclusionsA consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.

A contemporary analysis of acute mastoiditis.

Acute mastoiditis persists as a serious infection despite a dramatic decline in incidence coincident with the introduction of antibiotic therapy. To assist the contemporary practitioner in the recognition and management of acute mastoiditis through the assessment of a large series of patients. Retrospective case series comprising 124 patients with acute mastoiditis. Pediatric and adult otology referral center. Selected clinical parameters. Risk factors for necessity of surgical intervention and for increased length of hospitalization were analyzed by a stepwise logistic regression model. A history of antecedent acute otitis media was absent in 45% of patients. Pain (98%) was the most common presenting symptom. Physical signs included an abnormal-appearing tympanic membrane (88%), fever (83%), a narrowed external auditory canal (80%), and postauricular edema (76%). Streptococcus pneumoniae was the most commonly isolated organism. Mastoid surgery was required in 62% of the patients. An elevated white blood cell count (relative risk [RR], 7.4; P < .01), proptosis of the auricle (RR, 4.5; P = .03), and fever on admission (RR, 7.3; P = .05) were risk factors for surgical intervention. All 33 patients with complications (27%) proceeded to surgical intervention. The average length of hospital stay was 7.9 days. The strongest predictor for an increased length of hospital stay was whether the patient required surgery (RR, 3.7; P = .002). Acute mastoiditis remains a potentially serious otologic infection. Not all patients present with a classic history or physical examination. Therapeutic mastoidectomy is often required.